| NPI | 1225109002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 09778) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101022907) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-12-17 |