| NPI | 1447410949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: TX V8143) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 61114) |
| 2086S0129X (Licence: GA 61114) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2026-04-17 |