| NPI | 1770700619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 064520) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 5937) |
| 208600000X Surgery (Licence: SC 37767) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2016-02-05 |