| NPI | 1679713929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A121670) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101283877) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2024-12-05 |