| NPI | 1285165092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101285006) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D93558) |
| 208600000X Surgery (Licence: DE C1-0025035) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2025-05-07 |