| NPI | 1538142690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NV CL0727) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 20a8741) |
| 208600000X Surgery (Licence: GA 63249) | |
| 208600000X Surgery (Licence: SD 10247) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2025-07-29 |