| NPI | 1548581408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: WI 85933-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036131660) |
| 2086S0129X (Licence: SD 14378) | |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2025-08-19 |