| NPI | 1881661031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2015008450) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2015-00054) |
| 208600000X Surgery (Licence: IA 34184) | |
| 208600000X Surgery (Licence: IL 036105151) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2021-09-13 |