| NPI | 1487972972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ND 15256) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2017-00769) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2022-03-28 |