| NPI | 1659573111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD29110) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301082279) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2014-06-04 |