| NPI | 1306170444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301107424) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ AU-25035999616) |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2018-06-26 |