| NPI | 1801036728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS024438) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2014011221) |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2025-01-20 |