| NPI | 1104485648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E-19852) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL82795) |
| 208600000X Surgery (Licence: LA 341799) | |
| Enumeration Date | 2019-06-09 |
| Last Update Date | 2025-09-19 |