| NPI | 1427040823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 10476500-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID O-0397) |
| 208600000X Surgery (Licence: IN 02002432A) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2022-02-09 |