| NPI | 1265876106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 58412) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 28222) |
| 208600000X Surgery (Licence: KY TP657) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2023-09-25 |