| 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 |