| NPI | 1205027703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 000032615) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 8273638-8017) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2012-08-09 |