| NPI | 1922371962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A153886) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME110986) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2018-03-17 |