| NPI | 1497727671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2013-00879) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 36110) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2019-05-23 |