| NPI | 1265483184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101241143) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD37429) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2017-02-01 |