| NPI | 1164469748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME0108617) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2003031774) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2013-04-15 |