| NPI | 1770604803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MS 20437) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301076797) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2012-06-06 |