| NPI | 1235217241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TX N5329) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX N5329) |
| 2086S0129X (Licence: MO 2010007596) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-09-30 |