| NPI | 1437647757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 100704) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 05-47785) |
| 208600000X Surgery (Licence: MO 2023012244) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2024-10-03 |