| NPI | 1477545671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-33137) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2022008352) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2024-07-26 |