| NPI | 1447468236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A104905) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301077667) |
| 208600000X Surgery (Licence: NY 244628) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2018-01-25 |