| NPI | 1336554708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A169158) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301105704) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2021-03-12 |