| NPI | 1780649988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME0055039) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 00026990) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2007-10-02 |