| NPI | 1801982608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2017011939) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-28199) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2023-08-10 |