| NPI | 1457333940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 00019461) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 00019461) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2016-05-18 |