| NPI | 1487613022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: DE C1-0028199) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0044227) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2025-06-10 |