| NPI | 1457575813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2008033381) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL 25038) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2021-08-25 |