| NPI | 1700238250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2026-00765) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0094993) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2026-05-26 |