| NPI | 1689646507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 358614-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 71681) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2025-11-11 |