| NPI | 1295707214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00048958) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301076608) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2014-03-27 |