| NPI | 1851318885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: DC MD33973) |
| Additional Taxonomies | 174400000X Specialist (Licence: DC MD33973) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2016-02-09 |