| NPI | 1205988052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX M6083) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: ND 10408) |
| 208600000X Surgery (Licence: NV DO2111) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2025-12-03 |