| NPI | 1194769323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2007016643) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-32650) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2017-11-13 |