| NPI | 1083725527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101240105) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD d64435) |
| 208600000X Surgery (Licence: DC md036178) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-06-02 |