| NPI | 1669911574 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A19439) | 
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101022983) | 
| 208600000X Surgery (Licence: MI 5151012981) | |
| Enumeration Date | 2017-02-13 | 
| Last Update Date | 2025-09-04 |