| NPI | 1275775587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 71735) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY P) |
| 208600000X Surgery (Licence: TN 57079) | |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2022-07-05 |