| NPI | 1669542809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 0000029429) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 035505) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2010-12-14 |