| NPI | 1730676362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MI 4301504105) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301504105) |
| 2086S0129X (Licence: TX BP10084099) | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2025-06-24 |