| NPI | 1093916678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME 114954) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN11020) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2013-06-24 |