| NPI | 1073518049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME42578) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL 42578) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2013-03-22 |