| NPI | 1063518116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD13533) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD13533) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2013-04-15 |