| NPI | 1275067589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2023-01787) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME155570) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2024-05-13 |