| NPI | 1609936376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101039032) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0070730) |
| 208600000X Surgery (Licence: DC MD038685) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2011-11-07 |