| NPI | 1760974661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 87907) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5151009272) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2023-10-19 |