| NPI | 1861582678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 47114-020) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101248056) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2018-08-07 |