| NPI | 1437531845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2020-00789) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101022010) |
| 208600000X Surgery (Licence: MI 5151011201) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2020-11-09 |