| NPI | 1518227040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN DO-0000003634) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0102204412) |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2019-08-16 |