| NPI | 1033141635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MO 2016004892) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036-111255) |
| 208600000X Surgery (Licence: KS T 00734) | |
| 2086S0129X (Licence: IL 036-111255) | |
| 2086S0129X (Licence: KS T 00734) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2025-06-17 |