| NPI | 1356863146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2025-00737) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME163123) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2025-11-05 |