| NPI | 1386804359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101252553) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT192386) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2019-11-20 |