| NPI | 1023095718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101-032350) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101032350) |
| 2086S0129X (Licence: VA 0101-032350) | |
| 2086S0129X (Licence: VA 0101032350) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2022-01-27 |