| NPI | 1326273947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME 102230) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2009005331) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2014-06-17 |