| NPI | 1376838870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0058445) |
| Additional Taxonomies | 208600000X Surgery (Licence: WY TL4017) |
| 208600000X Surgery (Licence: KY 49401) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2018-03-17 |