| NPI | 1477073575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E-15410) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 94-09356) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2022-07-21 |