| NPI | 1891748539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 072654) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 52678) |
| 208600000X Surgery (Licence: ND 9950) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2019-10-17 |