| NPI | 1568665529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2026005715) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 37273) |
| 208600000X Surgery (Licence: WI 81558) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2026-06-23 |