| NPI | 1609996412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2007018560) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-32690) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2016-02-04 |