| NPI | 1497837405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 00025440) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35042412A) |
| 208600000X Surgery (Licence: MN 34132) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2007-07-08 |