| NPI | 1700801289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 200600242) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101055976) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-01-20 |