| NPI | 1407296064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A16540) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101020721) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2021-10-15 |