| NPI | 1902326846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MS 31947) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101023441) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2023-08-29 |