| NPI | 1003029430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 0536771) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2008004469) |
| 208600000X Surgery (Licence: OH 34.008845) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2022-01-27 |