| NPI | 1356518831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID o-0726) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: ID O-0726) |
| 208600000X Surgery (Licence: AK 179881) | |
| 208600000X Surgery (Licence: GA 82499) | |
| 208600000X Surgery (Licence: MT 93936) | |
| 208600000X Surgery (Licence: WY 13411C) | |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2023-01-30 |