| NPI | 1710140389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 41263) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-8389) |
| 208600000X Surgery (Licence: MN 108516) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2020-11-09 |