| NPI | 1336273234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NH 15274) |
| Additional Taxonomies | 208600000X Surgery (Licence: VT 060-0003194) |
| 208600000X Surgery (Licence: RI MD13262) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2015-03-05 |