| NPI | 1255693453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0076300) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 67072) |
| 208600000X Surgery (Licence: MN 62014) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2025-10-14 |