| NPI | 1003252453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-46162) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 55831) |
| 208600000X Surgery (Licence: MO 2024033958) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2026-04-15 |