| NPI | 1003842303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.047055) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 36177) |
| 208600000X Surgery (Licence: IN 01031348A) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2017-05-11 |