| NPI | 1255328266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 06964R) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 22011) |
| 208600000X Surgery (Licence: AZ 13972) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2016-11-23 |