| NPI | 1114092921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD31029) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2010-01694) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2014-12-18 |