| NPI | 1356970321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.156454) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME174405) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2026-06-25 |