| NPI | 1689659427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 4036) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 42530) |
| 208600000X Surgery (Licence: WI 51171) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2021-01-28 |