| NPI | 1407198575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-41101) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 94-08123) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2024-08-12 |