| NPI | 1033272661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 151643) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301085261) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2016-10-06 |