| NPI | 1972722247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 57024) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200001434) |
| 208600000X Surgery (Licence: MN 53988) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-09-15 |