| NPI | 1386632313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MI 4301111451) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 28809) |
| 208600000X Surgery (Licence: MI 4301111451) | |
| 2086S0129X (Licence: OK 28809) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2021-03-31 |