| NPI | 1811336241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 10933355-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY IP1433) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2024-04-24 |