| NPI | 1558569509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: HI 17901) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 9399487-1205) |
| 208600000X Surgery (Licence: VA 0101241525) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2017-04-11 |