| NPI | 1386848547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: AZ 23149) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 23149) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2008-01-22 |