| NPI | 1700802055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID 4561673) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101012308) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2025-03-21 |