| NPI | 1538124680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 12519) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101037661) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2008-01-02 |