| NPI | 1710970058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WY TL1909) |
| Additional Taxonomies | 174400000X Specialist (Licence: WI 41467-020) |
| 208600000X Surgery (Licence: WI 41467-020) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2012-09-12 |