| NPI | 1306057500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2013-00842) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 29764) |
| Enumeration Date | 2007-05-28 |
| Last Update Date | 2013-06-20 |