| NPI | 1376821447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL 15771) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301100534) |
| Enumeration Date | 2011-07-23 |
| Last Update Date | 2022-02-08 |