| NPI | 1104259597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 191435) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD27614) |
| 208600000X Surgery (Licence: AZ 71273) | |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2024-10-02 |