| NPI | 1689789083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 31350) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR E-3815) |
| 208600000X Surgery (Licence: MO 2002002474) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2017-05-10 |