| NPI | 1114906443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD25082) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD25082) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2015-09-30 |