| NPI | 1932156692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MT 12854) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 47825-020) |
| 208600000X Surgery (Licence: WA MD00037282) | |
| 208600000X Surgery (Licence: UT 8984752-1205) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2014-08-21 |