| NPI | 1598380883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101289186) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10070776) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2026-07-28 |