| NPI | 1609036326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-36857) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0076855) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2022-12-05 |