| NPI | 1659636272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-41202) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT202757) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2023-07-26 |