| NPI | 1962517086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0066139) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX J7765) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2021-05-05 |