| NPI | 1932300647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 79714) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 25520) |
| 208600000X Surgery (Licence: MI 4301084074) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2024-05-23 |