| NPI | 1962666263 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208600000X Surgery (Licence: DC MD037369) | 
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD19328) | 
| 208600000X Surgery (Licence: MD D0080365) | |
| Enumeration Date | 2008-07-15 | 
| Last Update Date | 2025-09-02 |