| NPI | 1467407031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2016-0486) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301056501) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2016-07-28 |