| NPI | 1871082594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR FE214427) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI MDR-7499) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2024-09-03 |