| NPI | 1114363462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 37038) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10046336) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2018-07-18 |