| NPI | 1245334762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0055850) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME83033) |
| 208600000X Surgery (Licence: LA MD22543) | |
| 208600000X Surgery (Licence: NM MD2013-0584) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2024-06-06 |