| NPI | 1457761181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2020-00894) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301500309) |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2020-10-27 |