| NPI | 1730753864 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL application-pending) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL pending) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2021-05-13 |