| NPI | 1548644933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA R10325) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036.162658) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2023-08-07 |