| NPI | 1467763227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 390200000x) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2018-02170) |
| Enumeration Date | 2010-06-27 |
| Last Update Date | 2023-08-14 |