| NPI | 1770698177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD11568) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00034893) |
| 208600000X Surgery (Licence: CA G56869) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2007-07-08 |