| NPI | 1194019968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2015006389) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 05-47062) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2023-01-24 |