| NPI | 1609365477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 05-53984) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2026040993) |
| 208600000X Surgery (Licence: IN 02008329A) | |
| 208600000X Surgery (Licence: AZ 011208) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2026-09-16 |