| NPI | 1922268283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT200717) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 237616) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2011-10-26 |