| NPI | 1639734106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101281359) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C1-0028359) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2025-06-19 |