| NPI | 1659483287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N1536) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA a94629) |
| 204F00000X Transplant Surgery (Licence: CA A94629) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2026-05-15 |