| NPI | 1679641427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C34455) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 011646) |
| 208600000X Surgery (Licence: HI MD2833) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2011-11-23 |