| NPI | 1497764187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 42300) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0051621) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2023-03-07 |