| NPI | 1386899078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D76143) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116019537) |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2013-09-23 |