| NPI | 1447491139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: GA 022231) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA AG5691452) |
| Enumeration Date | 2009-03-10 |
| Last Update Date | 2009-03-10 |