| NPI | 1700206299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101270266) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2019-00193) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2021-05-20 |