| NPI | 1356755110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 6034453-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301105892) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2022-08-12 |