| NPI | 1891775177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 32384) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 36114) |
| 208600000X Surgery (Licence: SC TL32384) | |
| 208600000X Surgery (Licence: NC 2018-02643) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2023-05-01 |