| NPI | 1508958323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 200601598) |
| Additional Taxonomies | 208600000X Surgery (Licence: VT 042-0016293) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2023-09-13 |