| NPI | 1245640218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL MD.34789) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 34789) |
| 208600000X Surgery (Licence: NC 2021-02476) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2025-05-20 |