| NPI | 1275928889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204F00000X Transplant Surgery (Licence: FL ME178000) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036155358) |
| 204F00000X Transplant Surgery (Licence: KY TP726) | |
| 204F00000X Transplant Surgery (Licence: KY 58643) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2026-06-01 |