| NPI | 1053362079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 27632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 27632) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2011-05-17 |