| NPI | 1689713620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101242107) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND 11969) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-02-05 |