| NPI | 1205015518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD29363) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 23934361205) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2026-01-05 |