| NPI | 1932292299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD23875) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00041739) |
| Enumeration Date | 2006-10-01 |
| Last Update Date | 2007-07-08 |