| NPI | 1467498295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101232343) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2015-02093) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2021-04-23 |