| NPI | 1669935631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MT MED-PHYS-LIC-156377) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 74548-20) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2025-11-16 |