| NPI | 1780879502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM A-1476-08) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101015726) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2025-08-06 |