| NPI | 1881009256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2019024497) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301106134) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2023-10-11 |