| NPI | 1669417598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NC 2025-00589) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2025-00589) |
| 2086S0129X (Licence: CA A52040) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2026-05-06 |