| NPI | 1811063134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101039629) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0033962) |
| 208600000X Surgery (Licence: DC MD15261) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2011-10-24 |