| NPI | 1144281445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P6622) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0066078) |
| 208600000X Surgery (Licence: CA AFE63478) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2014-11-11 |