| NPI | 1215922703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 3639) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 21990) |
| 208600000X Surgery (Licence: IA 30794) | |
| 208600000X Surgery (Licence: ND 8954) | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2007-07-08 |