| NPI | 1396944831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME118100) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116019085) |
| Enumeration Date | 2007-07-14 |
| Last Update Date | 2022-02-15 |