| NPI | 1558571851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM A-1658-12) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 1622503) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2012-04-17 |