| NPI | 1710172978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0065762) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2016-02096) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2023-01-09 |