| NPI | 1831191790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N7677) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0078496) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2025-06-05 |