| NPI | 1376834283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101272650) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD23957) |
| 208600000X Surgery (Licence: FL ME115595) | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2024-06-24 |