| NPI | 1730150772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL 0037088) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME37088) |
| Enumeration Date | 2006-01-29 |
| Last Update Date | 2019-09-04 |