| NPI | 1073142030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 284017) |
| Additional Taxonomies | 208600000X Surgery (Licence: VT 032.0134267) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2025-06-15 |