| NPI | 1881055705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-16804) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD250761) |
| Enumeration Date | 2016-03-20 |
| Last Update Date | 2022-10-31 |