| NPI | 1699095224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 055064) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 17051) |
| 208600000X Surgery (Licence: MA 243996) | |
| Enumeration Date | 2010-06-05 |
| Last Update Date | 2018-06-07 |