| NPI | 1386621407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5315018276) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301074208) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2023-02-15 |