| NPI | 1033314190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL ME112008) |
| Additional Taxonomies | 208600000X Surgery (Licence: PR 25992) |
| 208600000X Surgery (Licence: FL ME112008) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2025-10-16 |