| NPI | 1558546598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 74530) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200900109) |
| 208600000X Surgery (Licence: IL 036156249) | |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2025-01-30 |