| NPI | 1942384391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00039788) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 40371) |
| 208600000X Surgery (Licence: OK 25459) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2010-04-26 |