| NPI | 1518540590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5151014863) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101028027) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2026-04-03 |