| NPI | 1588005789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ND PT21722) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL 12884) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2024-12-11 |