| NPI | 1811146533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2011-01435) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN9753) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2021-05-27 |