| NPI | 1033187620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 36247) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 52913) |
| 208600000X Surgery (Licence: IL 036072703) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2026-08-03 |