| NPI | 1891709200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MS 15299) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA 44466) |
| 208600000X Surgery (Licence: AZ 37937) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2012-05-09 |