| NPI | 1215072095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: ME MD17413) |
| Additional Taxonomies | 2086S0129X (Licence: MA 223918) |
| 208600000X Surgery (Licence: ME MD17413) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2026-09-23 |