| NPI | 1457350936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101259047) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 97-00503) |
| 208600000X Surgery (Licence: NC 9700503) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2020-11-19 |