| NPI | 1376049817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0073780) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME175449) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2026-09-28 |