| NPI | 1851333785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX L6673) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR E-5028) |
| 208600000X Surgery (Licence: GA 060884) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2008-04-23 |