| NPI | 1215129549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS11728) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017517) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2012-11-14 |