| NPI | 1396765715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 200201622) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101259253) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-03-07 |