| NPI | 1457663163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO CDRH.0053765) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0053765) |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2020-07-07 |