| NPI | 1649245366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MN 62989) |
| Additional Taxonomies | 2086S0129X (Licence: UT 7657531-1205) |
| 208600000X Surgery (Licence: UT 7657531-1205) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2025-04-22 |