| NPI | 1043469455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME148086) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2014000402) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2023-05-03 |