| NPI | 1861406852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0104903) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101237460) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2025-11-11 |