| NPI | 1699941864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: DE C1-0010539) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116019143) |
| 208600000X Surgery (Licence: MN 55821) | |
| 208600000X Surgery (Licence: MN 106114) | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2023-08-14 |