| NPI | 1366503534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2009-00756) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 63872) |
| 208600000X Surgery (Licence: SC 33312) | |
| 208600000X Surgery (Licence: MS 17587) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-03-08 |