| NPI | 1043449085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MO 2022049480) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT194205) |
| 208600000X Surgery (Licence: MO 2022049480) | |
| 2086S0129X (Licence: LA MD455484) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2025-06-11 |