| NPI | 1689637290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 200101197) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD0000030619) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2026-01-11 |