| NPI | 1356846448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WY TL8974) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 29131) |
| 208600000X Surgery (Licence: MN 66304) | |
| 208600000X Surgery (Licence: WA MD61445708) | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2025-11-20 |