| NPI | 1164632410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 60324) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C7-0003751) |
| 208600000X Surgery (Licence: DE C1-0010142) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-11-22 |