| NPI | 1497894315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 12245) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 242418) |
| 208600000X Surgery (Licence: AZ 71758) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2015-07-22 |