| NPI | 1932474111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS16136) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR e-8208) |
| 208600000X Surgery (Licence: MS T-2951) | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2019-11-01 |