| NPI | 1568922797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 66824) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 30069) |
| 208600000X Surgery (Licence: MN 67780) | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2022-09-20 |