| NPI | 1932111390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2011-01979) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME86585) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2020-09-01 |