| NPI | 1205063450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME168412) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 260606) |
| 208600000X Surgery (Licence: NH 21909) | |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2024-10-03 |