| NPI | 1972565539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM 81-254) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 81-254) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2021-03-15 |