| NPI | 1043415490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 68904) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MT187650) |
| Enumeration Date | 2007-06-17 |
| Last Update Date | 2024-02-13 |