| NPI | 1427183722 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 70563) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME 018247) |
| 208600000X Surgery (Licence: MS 21966) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2019-02-14 |