| NPI | 1679885255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 0438150) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2010021735) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2020-12-02 |