| NPI | 1144285701 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208600000X Surgery (Licence: DE C1-0002968)  | 
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0067498)  | 
| Enumeration Date | 2006-04-18 | 
| Last Update Date | 2024-10-16 |