| NPI | 1659588846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301084022) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0062274) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2019-06-24 |