| NPI | 1003898982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME66544) |
| Additional Taxonomies | 174400000X Specialist (Licence: NE 17275) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2011-08-04 |