| NPI | 1366856866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD203597) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016019969) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2021-04-19 |