| NPI | 1831146125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 251073-1) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 39502) |
| 208600000X Surgery (Licence: MI 4301080957) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2014-07-21 |