| NPI | 1205886595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD11398) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD11398) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2019-04-10 |