| NPI | 1437185543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2010005331) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2005018417) |
| 208600000X Surgery (Licence: KS 05-34228) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2019-03-21 |