| NPI | 1790743276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101042991) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101042991) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2021-12-20 |