| NPI | 1578753034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: LA MD.203386) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA PGY.1.LSUN-SURG) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2016-11-15 |