| NPI | 1801859640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC TL31669) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200300326) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2014-07-16 |