| NPI | 1932544699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID 1171744) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101257822) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2025-01-08 |