| NPI | 1730243148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D37929) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101043363) |
| 208600000X Surgery (Licence: DC MD17763) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2012-12-20 |