| NPI | 1851386866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 33335) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 033335) |
| 208600000X Surgery (Licence: GA 033335) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2020-08-10 |