| NPI | 1386640076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-13897) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101230423) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2020-06-08 |