| NPI | 1447257209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101245506) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 0427231) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-11-16 |