| NPI | 1639107881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2022036986) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 35151) |
| 208600000X Surgery (Licence: KS 04-31862) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2022-10-21 |