| NPI | 1043770829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-50793) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2024045403) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-07-13 |