| NPI | 1750592861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2017-02145) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0052603) |
| 208600000X Surgery (Licence: VA 0101244537) | |
| 208600000X Surgery (Licence: NE 24363) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2024-05-29 |