| NPI | 1700856432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-50086) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 66366) |
| 208600000X Surgery (Licence: MN 30115) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2023-06-28 |