| NPI | 1477864288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2015029126) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 94-07544) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2016-03-22 |