| NPI | 1376726612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102202281) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 2285-T) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2009-09-29 |