NPI | 1205849791 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: OR MD15613) |
Additional Taxonomies | 208600000X Surgery (Licence: WA MD00034877) |
Enumeration Date | 2006-08-14 |
Last Update Date | 2007-07-10 |