| NPI | 1306899638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MA 72357) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 72357) |
| 208600000X Surgery (Licence: MA 72357) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2019-12-04 |