| NPI | 1740402965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS11465) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 03217) |
| 208600000X Surgery (Licence: OR LL16403) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2018-08-09 |