| NPI | 1710368527 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: KS 04-51739) | 
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-51739) | 
| 2086S0102X Surgery, Surgical Critical Care (Licence: KS 04-51739) | |
| Enumeration Date | 2015-06-17 | 
| Last Update Date | 2025-09-15 |