| NPI | 1962023226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0106147) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101287794) |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2026-04-15 |