| NPI | 1558497206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301095394) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA L-228805) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2022-07-14 |