| NPI | 1053387787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME97995) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101-234889) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2023-04-18 |