| NPI | 1215293832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083B0002X Preventive Medicine, Obesity Medicine (Licence: GA 104712) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 62015) |
| 2083B0002X Preventive Medicine, Obesity Medicine (Licence: NC 2025-00301) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2026-03-09 |