| NPI | 1093801334 |
|---|---|
| Former Name | N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME107287) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-7836) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-09-26 |