| NPI | 1588664106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 30153) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 43386) |
| 208600000X Surgery (Licence: GA 043386) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2018-08-15 |