| NPI | 1336208792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MA 230519) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 230519) |
| 208600000X Surgery (Licence: AZ 47597) | |
| 2086S0129X (Licence: AZ 47597) | |
| 2086S0129X (Licence: NH 16327) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2022-08-08 |