| NPI | 1942466420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD208908) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 55827) |
| 208600000X Surgery (Licence: MN 103907) | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2026-01-05 |