| NPI | 1528052297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 0416859) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-16859) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2008-10-20 |