| NPI | 1740486216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-10383) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60703609) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2025-09-10 |