| NPI | 1063492593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 28493) |
| Additional Taxonomies | 174400000X Specialist (Licence: WI 28493-020) |
| 2086S0129X (Licence: WI 28493-020) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2015-02-16 |