| NPI | 1497758668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101240741) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME0080795) |
| 208600000X Surgery (Licence: OH 35056592) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2010-11-19 |