| NPI | 1659806891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS21156) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT017672) |
| 208600000X Surgery (Licence: GA 95851) | |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2024-08-14 |