| NPI | 1043471121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 201601482) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI MD15359) |
| 208600000X Surgery (Licence: FL ME119715) | |
| 208600000X Surgery (Licence: DC MD039171) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2023-07-31 |