| NPI | 1295965457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 14065) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301095264) |
| 208600000X Surgery (Licence: MN 57567) | |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2023-11-01 |