| NPI | 1578884441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301106772) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-8979) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2025-03-13 |