| NPI | 1689634370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 35074) |
| Additional Taxonomies | 208600000X Surgery (Licence: MT 3657) |
| 208600000X Surgery (Licence: SD 0693) | |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2007-07-08 |