| NPI | 1366436628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2010-01781) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 037076) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2022-02-08 |