| NPI | 1497017727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R2200) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME EL191015) |
| 208600000X Surgery (Licence: ME MD23088) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2022-09-20 |