| NPI | 1821074907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 32479) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101242809) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2023-06-14 |