| NPI | 1255369989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MN 46028) |
| Additional Taxonomies | 174400000X Specialist (Licence: MN 46028) |
| 208600000X Surgery (Licence: MN 46028) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2024-08-09 |