| NPI | 1477577542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 8535A) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A83997) |
| 208600000X Surgery (Licence: CO 48808) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2010-12-07 |