| NPI | 1386608628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 0416653) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 0416653) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2019-02-14 |