| NPI | 1679502918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD157658) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301056816) |
| 208600000X Surgery (Licence: ID M10679) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-03-07 |