| NPI | 1952355273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 20220) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 036-085286) |
| 208600000X Surgery (Licence: WI 36216) | |
| 208600000X Surgery (Licence: IL 036085286) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2015-11-12 |