| NPI | 1871588145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101221384) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 35066) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2011-01-28 |