| NPI | 1790910420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2020-03262) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C2-0010875) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2024-05-17 |