| NPI | 1104015122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME104162) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2008009816) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2011-06-22 |