| NPI | 1881128221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-45828) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2022007515) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2022-06-29 |