| NPI | 1932338837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: IA DO-04841) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R - 8662) |
| 208600000X Surgery (Licence: IA DO-04841) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2019-01-10 |