| NPI | 1366496267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2015-0624) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101231512) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2021-08-11 |