| NPI | 1437536737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301503692) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2022-01362) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2023-01-20 |