| NPI | 1205956919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: KS 04-34821) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2022022320) |
| 208600000X Surgery (Licence: KS 94-06247) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CO CDR.001105) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2022-12-10 |