| NPI | 1558568303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: DE C1-0011902) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA MD39681) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2016-11-29 |