| NPI | 1164430716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME70211) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME70211) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2025-10-21 |