| NPI | 1023015823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME25808) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME0025808) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2008-06-05 |