| NPI | 1902885411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ND 11137) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200001214701) |
| 208600000X Surgery (Licence: NC 27560) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2016-02-25 |