| NPI | 1154437150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D 27411) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD 026300 E) |
| 208D00000X General Practice (Licence: MD D 27411) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2011-04-12 |