| NPI | 1659830768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 52400) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 83107-20) |
| 208600000X Surgery (Licence: MN 75889) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2024-08-06 |