| NPI | 1699752386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101-236195) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 01012361959) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2018-11-01 |