| NPI | 1336100619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 9801356) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME 82370) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2024-12-31 |