| NPI | 1972826618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 1676-321) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101018620) |
| Enumeration Date | 2010-03-09 |
| Last Update Date | 2026-03-23 |