| NPI | 1942290622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 4933554-1204) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO 14234) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2013-06-13 |