| NPI | 1861485617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VT 0420007770) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 8024) |
| 208600000X Surgery (Licence: WI 25436020) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2011-06-17 |