| NPI | 1891733366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MT MED-PHYS-LIC-122472) |
| Additional Taxonomies | 208600000X Surgery (Licence: WY 12723A) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2025-04-10 |