| NPI | 1932632312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 49111) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME162266) |
| 208600000X Surgery (Licence: LA 306149) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2024-08-06 |