| NPI | 1255782603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102207564) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101022779) |
| 208600000X Surgery (Licence: LA 326253) | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2024-04-26 |