| NPI | 1770606998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 14413) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2008012156) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2013-01-15 |