| NPI | 1982796355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5101011373) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI MR011373) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2026-06-01 |