| NPI | 1609223064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: UT 12792806-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D88188) |
| 2086S0129X (Licence: NM MD2024-1035) | |
| 208600000X Surgery (Licence: DC MD047589) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2025-12-31 |