| NPI | 1982667713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301053739) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 53739) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2010-09-15 |