| NPI | 1770789547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2013-01269) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL29864) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2024-05-29 |