| NPI | 1760486609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA MD.02605R) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 02605R) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2012-11-02 |