| NPI | 1942355821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 229810) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 8217884-1205) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2023-12-15 |