| NPI | 1417074717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 55715) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0102202269) |
| 208600000X Surgery (Licence: MN 59116) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2016-08-10 |