| NPI | 1811967268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A24169) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 5101013208) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2026-01-08 |