| NPI | 1558424671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 30455) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 35210) |
| 174400000X Specialist (Licence: TN MD0000030455) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2025-10-01 |