| NPI | 1316350432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101265062) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2015-02080) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2026-06-24 |