| NPI | 1184838286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101241891) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2015-02245) |
| 174400000X Specialist (Licence: VA 0101241891) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2018-03-17 |