| NPI | 1093972192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A121405) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 54487) |
| 208600000X Surgery (Licence: VA 0116018519) | |
| 208600000X Surgery (Licence: MN 105436) | |
| Enumeration Date | 2008-05-18 |
| Last Update Date | 2015-06-16 |