| NPI | 1417117078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301094372) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2008009951) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2012-02-01 |