| NPI | 1437127610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 46670) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 46670) |
| 208600000X Surgery (Licence: WV 26591) | |
| 208600000X Surgery (Licence: VA 0101226304) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2025-09-04 |