| NPI | 1265401947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M11497) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 38900) |
| 208600000X Surgery (Licence: MN 49923) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2013-07-24 |