| NPI | 1841459401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: NC 2025-00678) |
| Additional Taxonomies | 2086S0129X (Licence: NH LT-3174) |
| 2086S0129X (Licence: GA 83326) | |
| 208600000X Surgery (Licence: NH LT-3174) | |
| 2086S0129X (Licence: SC 83326) | |
| Enumeration Date | 2008-06-08 |
| Last Update Date | 2025-09-23 |