| NPI | 1871743104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2010008121) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101244387) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2023-01-20 |