| NPI | 1225033889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 0426508) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 102326) |
| 2086S0129X (Licence: MO 102326) | |
| 2086S0129X (Licence: KS 0426508) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2022-02-01 |