| NPI | 1730610866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX U5060) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2022-01301) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2023-09-08 |