| NPI | 1629180054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NE 27597) |
| Additional Taxonomies | 208600000X Surgery (Licence: SD 3563) |
| 208600000X Surgery (Licence: WY 5701A) | |
| 208600000X Surgery (Licence: NC 2007-01041) | |
| 208600000X Surgery (Licence: IA 41422) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-12-15 |