| NPI | 1043283468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D44696) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME0080564) |
| 208600000X Surgery (Licence: DC MD041431) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2022-03-17 |