| NPI | 1649252651 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ND ND3055) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M5897) |
| 208600000X Surgery (Licence: MT 3813) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2007-07-08 |