| NPI | 1699775494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME0052108) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101033738) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2010-10-07 |