| NPI | 1467455493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2015-01793) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 058287) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2020-11-12 |