| NPI | 1548763204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NV DO3455) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0063178) |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2023-08-10 |