| NPI | 1760430664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101263340) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 20486) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-07-10 |