| NPI | 1245481142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 22425) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME 102903) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2010-01-15 |