| NPI | 1023211000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301100509) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R7883) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2012-08-28 |