| NPI | 1649432840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2014-01062) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101017931) |
| Enumeration Date | 2008-06-28 |
| Last Update Date | 2014-06-04 |