| NPI | 1588924245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 82845) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 05445) |
| 208600000X Surgery (Licence: TN 55848) | |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2019-08-27 |