| NPI | 1932149630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00042984) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO 42129) |
| 208600000X Surgery (Licence: UT 1815591205) | |
| 208600000X Surgery (Licence: NC 21189) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2009-06-24 |