| NPI | 1508812827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 40081) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 34960) |
| 208600000X Surgery (Licence: WA 40479) | |
| 208600000X Surgery (Licence: KY 37194) | |
| 208600000X Surgery | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2007-07-08 |