| NPI | 1467453720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 30033) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 17160) |
| 208600000X Surgery (Licence: OH 35045444L) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2011-10-14 |