| NPI | 1528051919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D002450) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD12034) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2010-07-01 |