| NPI | 1114186053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 206713) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR E-9064) |
| 208600000X Surgery (Licence: PA MT196347) | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2026-07-30 |