| NPI | 1568690881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME119470) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL31954) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2016-11-04 |