| NPI | 1033473889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 05-3361) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2017014791) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2020-06-18 |