| NPI | 1821518531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A167624) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301112921) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2025-06-07 |