| NPI | 1376744979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: FL ME118812) |
| Additional Taxonomies | 2086S0129X (Licence: NC 2025-00439) |
| 208600000X Surgery (Licence: NC 2025-00439) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2025-11-03 |