| NPI | 1033316310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: LA MD.205820) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL30088) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2018-03-17 |