| NPI | 1447238068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2016-01469) |
| Additional Taxonomies | 2086S0129X (Licence: OR MD18841) |
| 2086S0129X (Licence: NC 2016-01469) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2026-04-02 |