| NPI | 1912904327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0028172) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 28172) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2015-02-03 |