| NPI | 1720311293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ME MD23721) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101249661) |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2025-03-10 |