| NPI | 1952506842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NH 20592) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI MD 15270) |
| 208600000X Surgery (Licence: MA 261554) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2020-06-11 |