| NPI | 1093710535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D43199) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200301039) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2013-12-08 |