| NPI | 1255303400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA DO-02888) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO R4H42) |
| 208600000X Surgery (Licence: IA 02888) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2018-09-28 |