| NPI | 1780063974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS17566) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101021646) |
| 208600000X Surgery (Licence: PA OS020605) | |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2021-04-05 |