| NPI | 1073574356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX K9945) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 23353) |
| 208600000X Surgery (Licence: LA MD.201045) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2012-09-20 |