| NPI | 1265685143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5101017672) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5315036001) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2016-06-17 |