| NPI | 1568681831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 57691-020) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2007014918) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-01-03 |