| NPI | 1336177211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 030763) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 030763) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2013-01-16 |