| NPI | 1285628990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD5824) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD5824) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2017-02-02 |