| NPI | 1689843534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 65573) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A100499) |
| 208D00000X General Practice (Licence: CA A100499) | |
| 208600000X Surgery (Licence: NY 258102) | |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2012-11-21 |