| NPI | 1477726271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MO 2023020247) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX M9261) |
| 2086S0129X (Licence: SC 91032) | |
| 2086S0129X (Licence: NH 34507) | |
| Enumeration Date | 2008-04-12 |
| Last Update Date | 2025-08-11 |