| NPI | 1073961280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: KS 04-46255) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 94-08982) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2022-06-14 |