| NPI | 1922109958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 63596) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 33669) |
| 208600000X Surgery (Licence: HI MD-7046) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2021-07-26 |