| NPI | 1447305818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0048303) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2009-00717) |
| 208600000X Surgery (Licence: UT 8187118-1205) | |
| 208600000X Surgery (Licence: MD D0057959) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2020-09-23 |