| NPI | 1811094089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 39766) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 0434355) |
| 208600000X Surgery (Licence: MO T2005016637) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-08-10 |