| NPI | 1497928972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 5178) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 50500) |
| 208600000X Surgery (Licence: ND 10849) | |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2020-07-11 |