| NPI | 1396703625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2010-0595) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M0961) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2017-02-02 |