| NPI | 1184674624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME108539) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 0428049) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2020-03-03 |