| NPI | 1235344128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME120434) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301087715) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2018-01-11 |