| NPI | 1457610396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-46733) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 273708) |
| 208600000X Surgery (Licence: MI 4301100177) | |
| Enumeration Date | 2012-05-13 |
| Last Update Date | 2020-07-08 |