| NPI | 1457791899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A17558) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0102203968) |
| Enumeration Date | 2013-06-30 |
| Last Update Date | 2021-07-06 |