| NPI | 1255777934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 009874) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT015332) |
| 208600000X Surgery (Licence: LA 324498) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2022-12-02 |