| NPI | 1639285422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ME MD17340) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM MD2005-0128) |
| 208600000X Surgery (Licence: KY 24310) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2012-06-29 |