| NPI | 1336170299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME101090) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD0000035863) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2016-09-08 |