| NPI | 1528283488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 27803) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301072012) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-10-22 |