| NPI | 1386930626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2017011918) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2011018406) |
| 208600000X Surgery (Licence: IA R-9569) | |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2023-07-25 |