| NPI | 1093823866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: DE C20003105) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS005405L) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-10-05 |