| NPI | 1881980126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R3076000) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2011018398) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2019-11-18 |