| NPI | 1710281340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME127794) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301097478) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2017-01-12 |