| NPI | 1740362458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 63899-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101050380) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2024-04-22 |