| NPI | 1730169566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 0055907) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0102203061) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2015-12-28 |