| NPI | 1285088591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 13409575-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 6511) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2023-08-02 |