| NPI | 1477641132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX M5494) |
| Additional Taxonomies | 174400000X Specialist (Licence: WI 45852-020) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2014-05-13 |