| NPI | 1548413008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E9313) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2014-00536) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2015-08-04 |