| NPI | 1144807827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 94-10729) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2021023183) |
| Enumeration Date | 2021-03-27 |
| Last Update Date | 2021-06-19 |