| NPI | 1679590657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2020033698) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO 41136) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2022-12-21 |