| NPI | 1699736942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA md00045614) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25ma07259500) |
| 208600000X Surgery (Licence: CA a43060) | |
| 208600000X Surgery (Licence: AK 5670) | |
| 208600000X Surgery (Licence: ID m-9374) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2012-01-26 |