| NPI | 1922489962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 38417) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101269486) |
| 208600000X Surgery (Licence: SC MMD.31487 LL) | |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2024-01-17 |