| NPI | 1447495387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-38715) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016008718) |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2021-10-25 |