| NPI | 1619930385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MA 273462) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 273462) |
| 2086S0129X (Licence: NH 20252) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2026-03-02 |