| NPI | 1558367235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2016-02106) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101-058377) |
| 208600000X Surgery (Licence: GA 074017) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2022-02-07 |