| NPI | 1366972341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 69478) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R76389) |
| 208600000X Surgery (Licence: OH 35.144114) | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2025-05-13 |