| NPI | 1578772513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: AL MD.42958) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016025178) |
| 2086S0129X (Licence: MO 2016025178) | |
| 2086S0129X (Licence: SC 92066) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2024-12-16 |