| NPI | 1871794305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0057106) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2010-01030) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2024-02-12 |