| NPI | 1396861407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 46117) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2004001484) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2008-10-21 |