| NPI | 1740254515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TX s8221) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S8221) |
| 2086S0129X (Licence: FL ME143785) | |
| 2086S0129X (Licence: MN 43750) | |
| 2086S0129X (Licence: AZ 41799) | |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2025-02-13 |