| NPI | 1578663191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME152122) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR E11250) |
| 208600000X Surgery (Licence: MO 2008035007) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2024-04-09 |