| NPI | 1811345978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME159903) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL39549) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2023-08-29 |