| NPI | 1801863139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 26192) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D54931) |
| 208600000X Surgery (Licence: PA pending) | |
| Enumeration Date | 2006-03-06 |
| Last Update Date | 2022-04-19 |