| NPI | 1710996020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 10454A) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 5005151205) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2019-02-01 |