| NPI | 1154502540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E-11787) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA MD.09302R) |
| 208600000X Surgery (Licence: FL ME73407) | |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2025-09-08 |