| NPI | 1487876017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 47375) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2010003271) |
| 208600000X Surgery (Licence: AR E-14225) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2021-06-21 |