| NPI | 1457553364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0064692) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101246689) |
| 208600000X Surgery (Licence: NC 2009-02030) | |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2021-05-18 |