| NPI | 1063435824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 82751) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 25445) |
| 208600000X Surgery (Licence: VT 042.0040351-COMP) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2026-07-15 |