| NPI | 1609431733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO CDR.0005547) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 0451742) |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2025-09-12 |