| NPI | 1194711713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS11914) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2000153636) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2015-02-17 |