| NPI | 1790766749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D84147) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101236528) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2019-05-28 |