| NPI | 1801973888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2022-02093) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 56084) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2022-10-11 |