| NPI | 1215945928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO CDRH.0050265) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301054136) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2025-05-08 |