| NPI | 1831200740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD21626) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD21626) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-01-29 |