| NPI | 1720014723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 22208) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD0000022208) |
| 2086S0129X (Licence: TN 22208) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2025-07-24 |