| NPI | 1215202148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 24920) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 28781) |
| 208600000X Surgery (Licence: FL ME60501) | |
| 208600000X Surgery (Licence: LA MD.017477) | |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2012-03-09 |