| NPI | 1396826640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101248811) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME127549) |
| 208600000X Surgery (Licence: NY 251807) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2024-03-07 |