| NPI | 1356389118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 51246) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 46717) |
| 208600000X Surgery (Licence: SD 7241) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2022-03-25 |