| NPI | 1700881950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 2779781205) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 46844) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2021-08-04 |