| NPI | 1427021658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN MD51981) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME0067909) |
| 208600000X Surgery (Licence: MI 4301088772) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2022-03-25 |