| NPI | 1316983745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 23469) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND 8239) |
| 208600000X Surgery (Licence: SC 9980) | |
| 208600000X Surgery (Licence: TN 25768) | |
| 208600000X Surgery (Licence: AK 4403) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2019-04-19 |