| NPI | 1801882758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD436706) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C10007690) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2012-10-18 |