| NPI | 1609937457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2008007224) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 0433045) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2017-12-08 |