| NPI | 1053517292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 48242020) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD30128) |
| 208600000X Surgery (Licence: NH 22332) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2026-07-02 |