| NPI | 1003919432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AK 5798) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO 48180) |
| 208600000X Surgery (Licence: WI 40784) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2013-06-25 |