| NPI | 1578539540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 3901) |
| Additional Taxonomies | 208600000X Surgery (Licence: SD 3907) |
| 208600000X Surgery (Licence: NE 14705) | |
| 208600000X Surgery (Licence: IA MD-22887) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2026-01-20 |