| NPI | 1548674989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2019014998) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-42370) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2024-12-06 |