| NPI | 1235240235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PR 016783) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD429473) |
| 208600000X Surgery (Licence: IL 036-113950) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-11-04 |