| NPI | 1194826925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61187283) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD13072) |
| 208600000X Surgery (Licence: WI 47612) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2025-03-19 |