| NPI | 1063508331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 8107) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA MD-39504) |
| 208600000X Surgery (Licence: NE 26672) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2025-12-10 |