| NPI | 1376003376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS23049) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0102208472) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2026-01-19 |