| NPI | 1659552347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-17090) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2008-01202) |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2023-03-24 |