| NPI | 1376550814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2012016539) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101240200) |
| 208600000X Surgery (Licence: KS 04-35308) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-05-06 |