| NPI | 1457652836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME134642) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301090388) |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2018-03-17 |