| NPI | 1306462882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2025-02510) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL84506) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2025-08-13 |