| NPI | 1073826178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR DO171722) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101018888) |
| Enumeration Date | 2010-07-17 |
| Last Update Date | 2015-12-09 |