| NPI | 1225256076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2007-00579) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-33427) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2021-04-14 |