| NPI | 1861477218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2016007347) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 023960) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2021-01-22 |