| NPI | 1326669409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MS 37265) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-50816) |
| 208600000X Surgery (Licence: TX BP10071314) | |
| 208600000X Surgery (Licence: MO 2025011100) | |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2026-07-01 |