| NPI | 1972556587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO #2004003249) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-30472) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2017-11-15 |