| NPI | 1376582445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 037116) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 037116) |
| 2086S0129X (Licence: SC 88373) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2022-08-02 |