| NPI | 1972790020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME0054121) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036-054967) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2018-11-15 |