| NPI | 1518313824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204F00000X Transplant Surgery (Licence: KY TP531) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2023-02598) |
| 208600000X Surgery (Licence: IL 036155268) | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2025-07-16 |