| NPI | 1861608192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2010016117) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101016459) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-12-05 |