| NPI | 1063651131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS11555) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125-051776) |
| Enumeration Date | 2009-02-13 |
| Last Update Date | 2026-01-19 |