| NPI | 1043715030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2023022425) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2024-00111) |
| 208600000X Surgery (Licence: KS 0447750) | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2024-05-16 |