| NPI | 1669521571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD69318) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 2920551205) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2024-01-29 |