| NPI | 1275910580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102209579) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT016601) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2025-10-16 |