| NPI | 1902817018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD058617L) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C10007635) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2016-01-08 |