| NPI | 1407803331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 2030) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 22313) |
| 208600000X Surgery (Licence: IA 24561) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2008-05-09 |