| NPI | 1790857167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 16015) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101232178) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2023-07-14 |