| NPI | 1477848851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID O-0937) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 4557) |
| 208600000X Surgery (Licence: MT 91207) | |
| 208600000X Surgery (Licence: WY 13251C) | |
| 208600000X Surgery (Licence: GA 81890) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2024-06-04 |