| NPI | 1407852718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C43219) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 25618) |
| 208600000X Surgery (Licence: CO 27659) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2008-02-25 |