| NPI | 1093979601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 7638432-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY r1179) |
| Enumeration Date | 2008-07-12 |
| Last Update Date | 2011-09-22 |