| NPI | 1407942493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: ME MD29604) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD29604) |
| 2086S0129X (Licence: NH 12817) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2025-08-05 |