| NPI | 1629496054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2024-02426) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101266662) |
| 208600000X Surgery (Licence: MA 291190) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2024-09-16 |