| NPI | 1871113183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2025-01837) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10070447) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2025-08-26 |