| NPI | 1255710166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME163115) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA L-262966) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2023-08-23 |