| NPI | 1639372840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 6979799-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 76323) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2010-01-25 |