| NPI | 1497862478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301056111) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 41107) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2021-02-03 |