| NPI | 1699717132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: KS 04-25812) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MO R9C64) |
| 208600000X Surgery (Licence: KS 04-25812) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2025-07-24 |