| NPI | 1750500591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: AZ 52469) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 205219) |
| 2086S0129X (Licence: LA 205219) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2016-12-28 |