| NPI | 1073726808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2024026173) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA DO-05218) |
| 208600000X Surgery (Licence: IL 036-127160) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2025-07-22 |