| NPI | 1942415153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 075295) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 27103) |
| 2086S0129X (Licence: GA 075295) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2016-09-06 |