| 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 |