| NPI | 1023025558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS014940) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017075) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2017-01-11 |