| NPI | 1558331363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD21051) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 014019) |
| 208600000X Surgery (Licence: AL 00015457) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2007-07-08 |