| NPI | 1265426738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 034068) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 034068) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2017-01-11 |