| NPI | 1124092085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 237242) |
| Additional Taxonomies | 2086P0122X Surgery, Physician Nutrition Specialist (Licence: MA 237242) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2025-12-15 |