| NPI | 1497806111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MP 0826) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 13258) |
| 208600000X Surgery (Licence: WI 39827) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2026-08-03 |