| NPI | 1356904361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 0449361) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2023048097) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2024-07-22 |