| NPI | 1811333206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX BP10047355) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR E-10862) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2018-06-05 |