| NPI | 1366489098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101250534) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2005010623) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2012-05-03 |