| NPI | 1366444168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D663825) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C1-0004741) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2011-09-21 |