| NPI | 1376626853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301049181) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME121890) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2026-03-25 |