| NPI | 1922087402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2009-01725) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 39528) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2012-05-11 |