| NPI | 1285745190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 05-38435) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 20A8917) |
| 208600000X Surgery (Licence: OK 5911) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2017-02-01 |