| NPI | 1679521082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101252390) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD24443) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2019-08-13 |