| NPI | 1952963811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 84647-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10066986) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2025-05-14 |