| NPI | 1306307855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL MD.41769) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2024034036) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2025-08-05 |