| NPI | 1003344060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-46181) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 94-09261) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2026-01-23 |