| NPI | 1518025741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 058558) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200300226) |
| 208600000X Surgery (Licence: NH 11600) | |
| 208600000X Surgery (Licence: IA 19275) | |
| 208600000X Surgery (Licence: ME TD061089) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |