| NPI | 1548233430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 16345) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2019-00136) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2023-10-10 |