| NPI | 1518935055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX M5393) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 74659) |
| 208600000X Surgery (Licence: ID M-11076) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2022-10-06 |