| NPI | 1356922264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC MMD.85916LL) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL MD.54198) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2026-06-16 |