| NPI | 1699708800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 7384) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM MD2005-0159) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2013-05-24 |