| NPI | 1326049834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME78234) |
| Additional Taxonomies | 208600000X Surgery (Licence: MT MED-PHYS-LIC-118181) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2025-10-06 |