| NPI | 1194817213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME 122305) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO MD R7B83) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2016-08-18 |