| NPI | 1164917548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0104123) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD484595) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2025-08-12 |