| NPI | 1063516243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-32408) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO T2006018043) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2007-07-08 |