| NPI | 1093819161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101029360) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200301509) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2016-08-04 |