| NPI | 1801868815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101050124) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 15881) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2022-07-21 |