| NPI | 1417338260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME160268) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2024-00153) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2024-05-13 |