| NPI | 1356507230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL ME175419) |
| Additional Taxonomies | 2086S0129X (Licence: NC 2015-00592) |
| 208600000X Surgery (Licence: NC 2015-00592) | |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2025-11-17 |