| NPI | 1487862272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MA 242715) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 242715) |
| 2086S0129X (Licence: VA 0101237807) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2022-01-07 |