| NPI | 1003980475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R0326) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND 9913) |
| 2086S0129X (Licence: ND 9913) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2026-03-17 |