| NPI | 1720131048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 11-00708) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2011-00708) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2025-03-26 |