| NPI | 1366979395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A179070) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A179070) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2025-08-20 |