| NPI | 1285263608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0098329) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD210012159) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2024-06-04 |