| NPI | 1952378549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101223190) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 40754) |
| 208600000X Surgery (Licence: NC 2006-01394) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2024-05-18 |