| NPI | 1639142474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 66422) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 20955) |
| 208600000X Surgery (Licence: MN 52105) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2017-02-03 |