| NPI | 1578734158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301086439) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 206790) |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2021-05-10 |