| NPI | 1710298195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 266410) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 245414) |
| 208600000X Surgery (Licence: HI DOSR 293) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2022-02-08 |