| NPI | 1861486839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 24584) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD24584) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2010-03-05 |