| NPI | 1871685685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2009004973) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 0430494) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2022-01-19 |