| NPI | 1003812942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0062161) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL OS14919) |
| 208600000X Surgery (Licence: PA OS014254) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2020-04-15 |