| NPI | 1831102011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX G2136) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR E0099) |
| 208600000X Surgery (Licence: VA 0101031485) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2007-07-08 |