| NPI | 1710961867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME82379) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 18415) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2020-04-06 |