| NPI | 1225235153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL 11972) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125048511) |
| 208600000X Surgery (Licence: MD 0070037) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2010-06-21 |