| NPI | 1205080652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME105034) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI MD447547) |
| 208600000X Surgery (Licence: MN 57500) | |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2015-08-12 |