| NPI | 1649265117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: DE C1-0024755) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME80209) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2025-06-10 |