| NPI | 1518958826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 36624) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 84924) |
| 2086S0129X (Licence: NC 36624) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2025-05-13 |