| NPI | 1649617101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 69317) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2018-00276) |
| 208600000X Surgery (Licence: VA 0101267191) | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2021-09-08 |