| NPI | 1962666263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0080365) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD037369) |
| 208600000X Surgery (Licence: ME MD19328) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2016-01-27 |