| NPI | 1881725935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 200200180) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX G1214) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2016-10-06 |