| NPI | 1144291758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 1016949) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME92672) |
| 208600000X Surgery (Licence: VA 0101049921) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2024-12-04 |