| NPI | 1528033644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WY TL#656) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 2894) |
| 208600000X Surgery (Licence: MI 5101015864) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2008-04-11 |