| NPI | 1942652458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0086028) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016012632) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2019-06-03 |