| NPI | 1376103606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 14018337-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5151013904) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2024-07-11 |