| NPI | 1609579564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: DC MD600005451) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0105748) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2026-03-16 |