| NPI | 1356403885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 62054) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 00026636) |
| 208600000X Surgery (Licence: MD D0098930) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2024-10-14 |