| NPI | 1093914731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 56252) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 6026964-1205) |
| 208600000X Surgery (Licence: OR MD150973) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2013-07-13 |