| NPI | 1366657256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2012-00168) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301088255) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2013-05-14 |