| NPI | 1669866844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2021-03341) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 29524) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2022-04-13 |