| NPI | 1275930554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101261221) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 22168) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2021-10-14 |