| NPI | 1639853625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 116037983) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116037983) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2024-03-27 |