| NPI | 1306829189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: DE C1-0010848) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 229066) |
| 208600000X Surgery (Licence: MD D0075452) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2015-12-21 |