| NPI | 1669911574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5151012981) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101022983) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2023-12-22 |