| NPI | 1932462280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS019471) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101020113) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2020-08-28 |