| NPI | 1427463280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2019-00926) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021272) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2019-07-12 |