| NPI | 1841295078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME0043817) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL 43817) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2013-05-23 |