| NPI | 1922294453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A112001) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NY 244781) |
| 208600000X Surgery (Licence: AZ 37724) | |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2013-09-13 |