| NPI | 1588923593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2019-02156) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2018019501) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2022-03-12 |