| NPI | 1669683967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NH 17837) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2012-01184) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-11-02 |