| NPI | 1144201278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101236472) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 27858) |
| 208600000X Surgery (Licence: GA 061521) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2012-09-28 |