| NPI | 1528083078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 0428647) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 22487) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-09-10 |