| NPI | 1720283310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD215325) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2017006874) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2024-03-25 |