| NPI | 1013960814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101046968) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 25499) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2010-02-03 |