| NPI | 1790710119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E7308) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX H5339) |
| 208600000X Surgery (Licence: KS 04-34106) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2016-02-15 |