| NPI | 1245341635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NM A-111099) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101010652) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-10-11 |