| NPI | 1013180876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301099598) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH T1019) |
| 208600000X Surgery (Licence: GA 001073) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2018-09-27 |