| NPI | 1265649487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A149114) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR E-4583) |
| 208600000X Surgery (Licence: FL ME123614) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2023-08-13 |