| NPI | 1336568096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2021-01749) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 72843-20) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2021-10-08 |