| NPI | 1407882582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: SC 22196) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 22196) |
| 2086S0129X (Licence: GA 049122) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2026-02-04 |