| NPI | 1629042122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD151172) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 29462) |
| 208600000X Surgery (Licence: TN 38146) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-07-21 |