| NPI | 1912944661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2018-0748) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 224930) |
| 208600000X Surgery (Licence: WI 49065) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2018-08-28 |