| NPI | 1558317446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301407413) |
| Additional Taxonomies | 208600000X Surgery (Licence: GU M001208) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2014-12-05 |