| NPI | 1750626461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G88270) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 184005-1205) |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2017-03-21 |