| NPI | 1164479325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 34564) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2011-00451) |
| 208600000X Surgery (Licence: ME 016904) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2019-01-22 |