| NPI | 1750386041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101221457) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101221457) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2022-02-17 |