| NPI | 1184911968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A14554) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101019363) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2016-05-26 |