| NPI | 1366948838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL 22769) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD H0100240) |
| 208600000X Surgery (Licence: PA OS024045) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2025-08-31 |