| NPI | 1811144181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: AZ 011868) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 061656) |
| 2086S0129X (Licence: GA 061656) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2025-08-20 |