| NPI | 1710908173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101257791) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2005-01880) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2020-04-27 |