| NPI | 1932453966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301032002) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME18642) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2012-10-29 |