| NPI | 1366647885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 8567) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 55560) |
| 208600000X Surgery (Licence: MN 106189) | |
| 208600000X Surgery (Licence: KS 046765) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2022-03-25 |