| NPI | 1376865261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME122699) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301092876) |
| Enumeration Date | 2010-02-19 |
| Last Update Date | 2024-08-07 |