| NPI | 1609296763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD217472) |
| Additional Taxonomies | 204F00000X Transplant Surgery (Licence: OR MD217472) |
| 208600000X Surgery (Licence: CA A139699) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2025-07-16 |