| NPI | 1972507705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: KS 04-40402) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-40402) |
| 2086S0129X (Licence: MO 2002012294) | |
| 208600000X Surgery (Licence: MO 2002012294) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2025-09-23 |