| NPI | 1497717011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 6214940-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0046382) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2008-07-08 |