| NPI | 1700299203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 70554-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301105071) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2019-06-19 |