| NPI | 1528321536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TX R2433) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10043016) |
| 208600000X Surgery (Licence: TX R2433) | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2025-10-17 |