| NPI | 1790714897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301031263) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI MG031263) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2007-12-13 |