| NPI | 1275515538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 200301402) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200301402) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2018-03-17 |