| NPI | 1396991501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 25985) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 201200244) |
| 208600000X Surgery (Licence: IL 036126755) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2026-08-19 |