| NPI | 1316151897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 64031-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2014-01169) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2015-08-18 |