| NPI | 1508072190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA DO-05297) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2007011380) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2019-01-04 |