| NPI | 1346256955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301102274) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD22778) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2013-05-06 |