| NPI | 1750050373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 85265-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 31458) |
| 208600000X Surgery (Licence: MN 78021) | |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2025-08-01 |