| NPI | 1881792463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA MD203157) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO T2003013852) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2010-03-03 |