| NPI | 1134113210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101230770) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101230770) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2016-06-16 |