| NPI | 1336165562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 1014346) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2018-00598) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-06-22 |